618 EPITOME OF MODERN TREATMENT 



to reopen a wound and remove sutures, if infection occurs, but to secure 

 a first intention is impossible when the wound has become generally in- 

 fected. The first dressing should always be retained as long as possible to 

 avert infection. If the wound becomes infected employ bacterins. 



Bier's Hyperemia Treatment. — Passive hyperemia is secured by suction, 

 as cupping and the use of other suction apparatus, and also by placing an 

 elastic ligature about a part sufficiently tight to prevent the return of 

 venous blood, but not so tight as to obstruct the arterial inflow. 



Passive hyperemia is useful in infections and inflammations — particularly 

 of limbs and joints — because of the following actions: 1. Bactericidal 

 effect. 2. Relief of pain. 3. Resolution of inflammatory deposits and relief 

 of stiffness in joints. 4. Arrest of absorption of toxins into circulation. 5. 

 Shortening or aborting infections. 



Methods of application. — A rubber Esmarch bandage, about 3 inches wide 

 and 5 feet long, is wound about the limb of a horse tight enough to produce 

 a warm edema below the bandage. The ' bandage is kept in place 20 hours 

 out of the 24, in severe cases; or 10 hours in the 24, in milder infections. 

 Just how tight to apply the bandage is not possible to describe. In the 

 horse the chief point is to avoid producing a cold limb because of too great 

 constriction. Some animals will bite or paw and so displace the bandage. 

 The rubber bandage should have tapes sewn on each end, and is wrapped 

 about the limb and kept sufficiently tight by tying the two tapes together. 

 The bandage is placed in the forelimb on the forearm above the chestnut 

 one day, and the next below the knee (on the metacarpus), and so shifted 

 from day to day. In the hind limb the bandage is placed one day about the . 

 middle of the tibia, and the next day below the hock. It should always be 

 placed as far above the lesion as possible, but in the horse it can not 

 be affixed at groin and axilla, as in man. The position of the bandage is 

 shifted from day to day to avoid necrosis of the skin. It is well to protect 

 the rubber by a cloth bandage over it. If the infection is of the knee or 

 hock, the constriction must be above these points. 



The bandage should be applied at the earliest stage of infection to secure 

 the best results. Then edema may be expected from the bandage, but, in 

 later stages, edema may not occur, and if this is the case the treatment 

 is of little service. If the treatment is successful either pus will not form 

 and resolution occur, or else it will be necessary to make but small in- 

 cisions to liberate pus, and the course of the condition should be much 

 shortened. The treatment is only applicable to cases which can be under 

 frequent observation in order that the obstruction produced by the bandage 

 may be regulated. Placing the finger under the bandage after its applica- 

 tion wiU give one an idea of the amount of pressure, and observation of 

 the limb wiU show one if the result is obtained — edema, but warmth in 

 the distal parts, with apparent relief of pain. The turns of the elastic 

 bandage should spread over some area of skin and not be applied one over 

 the other. 



The appropriate conditions in veterinary practice for Bier's hyperemia 

 include the following: Infections of the sheaths of tendons and about the 

 feet from injuries, punctures, etc.; joint infections and stiff joints, in- 

 cluding rheumatic joints. These embrace purulent tenosynovitis and ar- 

 thritis, and phlegmons about the hoof in horses. A wet antiseptic dressing 

 may be applied loosely over the point of infection. It is yet to be proved 

 of how much value this method is in veterinary practice, although many 

 favorable reports have been made. 



Infected and contused wounds should be treated by the application of 

 aseptic gauze soaked in 2 per cent, compound cresol solution, covered with 

 oil silk and bandage and renewed each day, until the septic condition has 

 been somewhat overcome. The use of a mixed bacterin, at the outset may 

 greatly shorten the period of healing. Unhealthy granulations are treated by 

 applications of lunar caustic and stimulant, antiseptic remedies, as Peruvian 

 balsam or carbolic acid in glycerin (1-10-— 16). A bandage should always 

 be employed when possible. Otherwise, healing may be had under a scab 



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